Utilization of Emergency Medical Services by Culturally and Linguistically Diverse Patients: A Population-Based Retrospective Study

Objectives: To compare emergency medical services (EMS) utilization between culturally and linguistically diverse (CALD) and non-CALD patients in Victoria, Australia. Methods: A retrospective study of EMS attendances and transports in Victoria from January 2015 to June 2019, utilizing linked EMS, hospital emergency and admissions data. The CALD and non-CALD patients who received EMS care and transport to a Victorian public emergency department were included. The incidence of EMS use for CALD and non-CALD patients based on the 2016 Census population and expressed per 100,000 person-years. Results: In 1,261,167 included patients, there were 272,100 (21.6%) CALD and 989,067 (78.4%) non-CALD patients. Before adjustment for age and sex, EMS utilization for CALD patients was 13% lower than non-CALD patients (incidence rate ratio [IRR] 0.87, 95% CI: 0.87–0.87). When stratified by age groups, CALD patients aged under 70 years had significantly lower rates of EMS utilization than non-CALD patients, while CALD patients aged 75 years or older were more likely than non-CALD patients to use EMS (IRR 1.08, 95% CI: 1.07–1.09). The CALD patients were less likely to utilize EMS for trauma/external injury (IRR = 0.67, 95% CI: 0.66–0.68) and mental health/alcohol/drug problems (IRR = 0.39, 95% CI: 0.38–0.40). After adjustment for differences in the age and sex distribution of CALD and non-CALD populations, CALD patients were 51% less likely to utilize EMS than non-CALD patients (IRR 0.49, 95% CI: 0.42–0.56). Conclusions: The CALD patients used EMS less frequently than non-CALD patients with significant variation observed across age groups, countries of birth, and clinical presentation. Further research is needed to understand the factors that may be contributing to these disparities.